Management of Duodenal Injuries

Abstract

The duodenum is mostly a retroperitoneal structure, composed by 4 segments (D1-D4) and surrounded by other vital organs like pancreas or great vessels. Injuries to this organ are rare and difficult to diagnose, with an incidence of 1–5% in cases of abdominal trauma. The most common causes of duodenal injuries are gunshot wounds and stabbing. Duodenal injuries are often associated with other organ injuries, thus delaying diagnosis in some cases and increasing the risk of complications. When diagnosed at optimum timing, it can be treated with relatively low mortality rates. Great number of repair techniques exist and the treatment of choice depends on the surgeon’s experience and hemodynamic stability of the patient, with the goal of preserving life and preventing a major complication such as leak or fistula. Outcomes are good, and the prognosis is tightly ligated to associated injuries, thus high index of suspicion and applying ATLS and surgery trauma principles are essential.